A comparative study of Less Invasive Stabilization System (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures.

The present investigation is a prospective study comparing the use of locked plates and classic double plates for the repair of bicondylar tibial plateau fractures. Eighty-four patients with bicondylar tibial plateau fractures were treated with plate fixation by either a locked plate (Less Invasive Stabilization System, LISS) or classic double plates (DP). All patients were followed for a minimum of 24 months. Outcomes were assessed by recording the surgical experience with each approach, post-operative complications and improvements in knee function as measured by the Hospital for Special Surgery (HSS) score. For all patients, no differences in the mechanisms of injury, fracture type, open fracture grade, mean age, gender distribution, associated medical conditions, pre-surgical stay, surgical time, bony union rate or radiographic healing times were observed between the two groups. Also, the HSS score and incidences of infection, seroma, hematoma, deep venous thrombosis, loss of reduction, loss of alignment, hardware failure and overall post-operative complications were all similar in both groups (P>0.05). Wound size and blood loss were significantly less in the LISS group than in the DP group (both P<0.05). A significantly higher incidence of post-operative malalignment of the proximal tibia (P=0.041) and a trend toward significance of a higher incidence of symptomatic hardware irritation (P=0.057) were observed in the LISS group compared to the DP group. In conclusion, LISS provides an alternative treatment for bicondylar tibial plateau fractures, but it may not replace the conventional two-incision double plating technique as the standard of care.